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    Incontinence after RP or RT: Consider preventive measures first

     

    How common is incontinence in men who undergo radical prostatectomy and those who undergo radiation therapy?

    Most men undergoing RP see a rapid improvement in continence over the first several months after the catheter is removed and continue to regain their bladder control over time. They are usually considered to have reached their full recovery within 6 to 12 months after surgery. With RP, two types of incontinence can occur: urge urinary incontinence due to changes in the bladder after surgery and stress urinary incontinence, usually attributed to damage to the external sphincter muscle. Men usually experience some type of stress incontinence immediately after the catheter is removed.

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    In men undergoing RP, long-term incontinence rates can vary depending on the study, ranging anywhere from 2% to 80% (J Urol 1998; 160:1317–20). These numbers are dependent on the definition of urinary incontinence used and the methodology used in collecting the data.

    There are several patient factors that can contribute to urinary incontinence after surgery. These include the age of the patient at the time of surgery and his weight (BMI). We know that in larger studies, increasing age leads to higher rates of male urinary incontinence. Additional patient factors include whether or not the patient had prior surgery on the bladder or prostate, the presence of an enlarged prostate, and the strength of the patient’s pelvic floor muscles.

    Another factor is the skill, experience, and technique of the surgeon, which can significantly contribute to incontinence outcomes. The aggressiveness of the cancer itself is an additional factor.

    In men undergoing EBRT or brachytherapy (not considered in this study), incidence of urinary incontinence can range from 10% to 30% in some studies. Again, this is dependent on whether the incontinence reports are from the patient or the provider.

    Also see: Older drug, versatile clinicians may help IC/PBS patients

    Urinary incontinence in these men can develop months to years after radiation therapy. The other patient factors we discussed with RP also can contribute to incontinence following radiation therapy.

    Next: Key considerations for nurses and other allied health professionals

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